Provider Demographics
NPI:1700268075
Name:SALAZAR, ROBERTA (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 TORONTO ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-5220
Mailing Address - Country:US
Mailing Address - Phone:719-242-8758
Mailing Address - Fax:
Practice Address - Street 1:311 W 24TH ST STE 2
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2471
Practice Address - Country:US
Practice Address - Phone:719-242-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099269461041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical